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Weight-based Dosing Lipid Injectable Emulsion for Parenteral Nutrition on Glycemic Control in Adult Hospitalized Patients
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Weight-based Dosing Lipid Injectable Emulsion for Parenteral Nutrition on Glycemic Control in Adult Hospitalized Patients
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Journal Article
Weight-based Dosing Lipid Injectable Emulsion for Parenteral Nutrition on Glycemic Control in Adult Hospitalized Patients
2024
Overview
Background: Hyperglycemia and hypoglycemia are associated with undesirable clinical outcomes. Patients receiving parenteral nutrition (PN) are at increased risk due to the intravascular administration of dextrose. Lipid injectable emulsion (ILE) is also a component of PN, however, administration practices for ILE vary widely, with unknown implications for blood glucose control. Research Objective: This cross-sectional study explored the incidence of hyper- and hypoglycemia in hospitalized patients before and after a clinical practice change designed to base ILE on patients weight (i.e., 50 gm/day for< 75 kg, 100 gm/day for >/= 75 kg). Methods: Patients with weight >/= 75 kg with sole PN support at a goal rate for >/= 3 days were included based on the ILE dosing guideline in Nebraska Medicine. Baseline demographic, clinical, nutritional, and blood glucose-related data were collected and analyzed in the first 24 and 24-48 hours. Results: 112 patients were included (58 NWBD and 54 WBD). The adjusted ORs (aOR) from the multivariate logistic regression model showed hyperglycemia risk in the first 24 hours after PN at the goal rate decreased by 67% for the WBD compared to the NWBD (P = 0.022, aOR = 0.330 [95%CI: 0.127, 0.854]). Additionally, patients with type 1 or type 2 diabetes were more likely to have hyperglycemia events in the first 24 hours of PN initiation (P< 0.0001, aOR = 13.075 [95%CI: 4.297, 39.789]). The risk of hypoglycemia between the two groups was not significant. Discussion: The WBD ILE can improve hyperglycemia events in hospitalized patients with PN support, especially when they have been diagnosed with diabetes. We recommend dosing 100 g/d ILE for patients of weight >/= 75 kg to meet the daily lipid requirements and improve glycemic control.
Publisher
Dietitians of Canada
